The purpose of this policy and procedure is to provide mandatory guidance for the creation, storage, use, disclosure and exchange of information when acting as part of or on behalf of the ACCESS Sonoma IMDT.
This policy and procedure applies to all entities and individuals participating in or acting on behalf of the ACCESS Sonoma IMDT. All Participating Agencies must sign a Participating Agency Agreement and all participating Workforce Members must sign a Confidentiality Statement.
A variety of state and federal laws protect the confidentiality of an individual’s health, behavioral health, and social service information, including, but not limited to: the Health Insurance Portability and Accountability Act (HIPAA) and its implementing regulations (45 C.F.R. Parts 160 and 164); California’s Confidentiality of Medical Information Act (CMIA) (Cal. Civ. Code § 56 et seq.); the Lanterman-Petris-Short (LPS) Act (Cal. Welf. & Inst. Code § 5000 et seq.); federal Substance Abuse Confidentiality Regulations (42 C.F.R. Part 2); California substance use disorder laws (Cal. Health & Safety Code 11845.5 and 11812); and HIV test result laws (Cal. Health & Safety Code §§ 121020, 120980). To meet the challenges associated with sharing the information of vulnerable residents, Sonoma County has developed a consent-based model that limits enrollment in the ACCESS Sonoma IMDT Initiative to clients who authorize their information to be shared by and between the participating entities on the ACCESS Sonoma IMDT. This model is necessary because the IMDT approach is premised on unrestricted information sharing between participating IMDT entities to help clients get the services and resources they need. Clients who do not consent to share their information may separately seek any of the services offered by the participating entities and will not be denied assistance based on their decision not to enroll in the ACCESS Sonoma IMDT.
- ACCESS Sonoma IMDT
The ACCESS Sonoma IMDT consists of case managers, treatment providers, and support staff who provide case management and related services to Cohorts of vulnerable individuals that are identified by the Safety Net Collaborative. The ACCESS Sonoma IMDT includes both a Core Group of subject matter specialists who meet regularly to support overall goals of the ACCESS Sonoma Initiative and Cohort Care Teams that provide case management to specific Cohorts.
- Assembly Bill (AB) 210
AB 210 (Cal. Welf. & Inst. Code § 18999.8) authorizes counties to establish homeless adult and family multidisciplinary teams (MDTs) to facilitate the expedited identification, assessment, and linkage of homeless individuals and families to housing and supportive services within the County. It allows provider agencies to share otherwise confidential information in order to coordinate services, ensure continuity of care, and reduce duplication of services. The Sonoma County AB 210 MDT is part of the ACCESS Sonoma IMDT, and subject to this policy.
- Care Manager Interface
The Care Manager Interface within Watson Care Manager allows Workforce Members to input and view client demographics, case notes, care plans, client goals and other information relevant to client case management. The Care Manager Interface does not directly receive information from outside electronic databases (information must be added by Workforce Members).
Cohort refers to a group of clients designated to receive intensive case management and related services through the Access Sonoma IMDT. Cohorts are identified and defined by the Safety Net Collaborative. Clients must be assigned to a Cohort before they may receive services through the ACCESS Sonoma IMDT Initiative.
- Cohort Care Team
Cohort Care Teams provide services and case management to Cohorts. Workforce Members who have been assigned to a Cohort Care Team are members of the Access Sonoma IMDT.
- Core Group
Core Group refers to those specific subject matter experts that support the overall goals of the ACCESS Sonoma Initiative. The members of the Core Group and the Participating Agencies they represent are identified in Attachment A, which may be updated by the ACCESS Sonoma IMDT Manager with the approval of the Privacy Committee.
- IMDT Authorization
IMDT Authorization refers to a client’s consent to release otherwise confidential information for the purpose of intensive case management and service delivery by Workforce Members of the ACCESS Sonoma IMDT.
- Participating Agencies
Participating Agencies in the ACCESS Sonoma IMDT include County Departments, agencies affiliated or contracted with the County, governmental agencies, and non-governmental agencies. All Participating Agencies have, as one of their purposes, the care, care management, or rehabilitation of high-needs, vulnerable populations. All Participating Agencies must agree to be bound by this policy and execute the Participating Agency Agreement before sharing information for the purposes of the ACCESS Sonoma Initiative. New Participating Agencies may be designated by the ACCESS Sonoma IMDT Manager with the approval of the Privacy Committee. Participating Agencies are identified in Attachment A.
- Privacy Committee
The Privacy Committee is a workgroup of the Safety Net Collaborative that meets as needed to consider privacy issues related to the ACCESS Sonoma Initiative. The Privacy Committee reports to the Safety Net Collaborative. The Privacy Committee shall consist of the County Privacy Officer, a representative with the Information Services Department, the ACCESS Sonoma IMDT Manager, one or more representatives with the Cohort Care Teams, a representative with County Counsel, and a representative with each Safety Net Department. The Privacy Committee shall establish a charter, to be approved by the Safety Net Collaborative, under which the Safety Net Collaborative may delegate certain privacy and other administrative responsibilities to the Privacy Committee.
- Safety Net Collaborative
The Safety Net Collaborative is a group consisting of the Department Head of each Safety Net Department, or his or her designee. The Safety Net Departments are the Department of Health Services, the Human Services Department, Probation, the Department of Child Support Services, the Sonoma County Community Development Commission, the District Attorney, the Sonoma County Sheriff’s Office, and the Public Defender.
- Virtual Client Record
The Virtual Client Record is a component of Watson Care Manager that offers a view of selected client information uploaded from the County’s mental health system (Avatar), Substance Use Disorder programs (SWITS), Housing systems (HMIS, HAPPY, etc.), Integrated Justice System, and Social Services systems (Cal Win).
- Watson Care Manager
The Integrated Case Management System (Watson Care Manager) is the primary tool that the ACCESS Sonoma IMDT uses to support case management and information sharing. It is an electronic system with two components: (1) the Virtual Client Record; and (2) the Care Manager Interface.
- Workforce Member
Workforce Members, for the purpose of these policies and procedures, includes any individual whose conduct, as part of the ACCESS Sonoma IMDT, is on behalf of, or under the direct control of the County or a Participating Agency. Workforce Members may include, but are not limited to, County employees (full-time, part-time, extra help), contracted individuals, unpaid interns, temporary agency workers, and registered volunteers.
- Description of the IMDT Authorization
The IMDT Authorization, included as Attachment B, authorizes the disclosure of information to the ACCESS Sonoma IMDT and the exchange of information between entities and individuals participating in the ACCESS Sonoma IMDT. The IMDT Authorization requires the client to agree that all members of the IMDT may share all information with each other, including substance-use-disorder (SUD) and mental health information. Clients who do not agree that their information may be disclosed to members of the IMDT will not be enrolled into the program because the core nature of the services offered involve unrestricted information sharing.
- Purpose of the IMDT Authorization
In some cases, health care providers or other entities may share information about a client without the client’s consent. For example, a physician can share information about a patient’s diabetes with a hospital that has admitted that patient for the purpose of treating the patient. Similarly, a community clinic could share information about a patient’s visit in order to obtain payment for the visit. For these reasons, many ACCESS Sonoma information sharing activities would be permissible under the applicable laws whether or not the client has signed the IMDT Authorization.
However, because of the complexities of federal and state privacy laws applicable to services for vulnerable populations, IMDT Workforce Members may not be certain of their ability to share client information or may conclude that sharing is not permissible without the client’s consent. These concerns are particularly relevant with respect to SUD and mental health information, which is frequently at issue when providing services to the vulnerable populations served by the ACCESS Sonoma IMDT Initiative. The IMDT Authorization ensures that IMDT members may permissibly share all relevant information with each other as they work to get clients the services they need.
- Requests to Limit IMDT Authorization
Clients may request limitations on the sharing of their data. Consistent with applicable laws, the Privacy Officer or his designee will review those requests to determine if they are feasible. However, due to the nature of the ACCESS Sonoma IMDT Initiative, and the need to accommodate the Watson Care Manager platform, many such requests may not be able to be accommodated.
The Privacy Officer or his designee shall review requests for limitations on data sharing in accordance with the standards set forth in the Sonoma County Board of Supervisors Administrative Policy 9-2, and shall comply with state and federal guidelines. The County is not obligated to agree to patient requests for restrictions. All such requests for limitations on data sharing will be responded to in writing.
- Documentation of IMDT Authorization
If the client consents to information sharing, he or she will need to sign and date the IMDT Authorization. The IMDT Authorization may be signed electronically. The IMDT Authorization may be signed by the client’s personal representative (such as a parent or legal guardian), as long as the personal representative indicates his or her relationship to the client. The signed IMDT Authorization will be available electronically in Watson Care Manager. If a paper authorization is signed instead of an electronic one, a scanned copy will be available.